Active NPI
Colette Randol, MSW
- Social Worker
- Fort Wayne, IN
National Provider Identifier
1265174973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 99109008A
- Practice address
- 750 Broadway Ste 350
Fort Wayne, IN 46802-1412 - Phone
- (260) 423-2675
- Fax
- (260) 423-6621
- NPI assigned
- Apr 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 99109008A | IN | Primary |
Addresses
Primary practice location
750 Broadway Ste 350
Fort Wayne, IN 46802-1412
Mailing address
750 Broadway Ste 350
Fort Wayne, IN 46802-1412
Phone (260) 423-2675
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99109008A | IN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649721600000",
"number": "1265174973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "750 BROADWAY STE 350",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468021412",
"telephone_number": "260-423-2675",
"fax_number": "260-423-6621"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 BROADWAY STE 350",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468021412",
"telephone_number": "260-423-2675",
"fax_number": "260-423-6621"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOL",
"first_name": "COLETTE",
"credential": "MSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-12",
"last_updated": "2022-04-12",
"certification_date": "2022-04-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IN",
"license": "99109008A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.